Pediatrics 1989 May;83(5):723-6

Perioperative factors affecting the outcome following repair of biliary atresia

Lally KP, Kanegaye J, Matsumura M, Rosenthal P, Sinatra F, Atkinson JB
Division of Pediatric Surgery, Childrens Hospital of Los Angeles, CA 90027

Abstract
The records of all patients with biliary atresia seen at the Childrens Hospital
of Los Angeles during a 14-year period were reviewed. Of the 41 patients who
could be evaluated, 32 were treated with trimethoprim and sulfamethoxazole
prophylaxis, five were given other agents, and four received no prophylaxis
after surgery. At least one episode of cholangitis occurred in nine patients.
With one exception, all patients destined to have cholangitis did so within 9
months of surgery. Of the nine patients, five were receiving prophylaxis at the
time the disease developed, but two were no longer receiving any prophylaxis.
The other two patients in whom cholangitis developed never received antibiotic
prophylaxis. In the 24 patients who had a Kasai type of portoenterostomy,
cholangitis developed in three of the five (60%) with a Roux-en-Y limb length
less than 40 cm and in two of the 19 (10.5%) with limb lengths greater than 40
cm (P less than .02). When performed earlier than 61 days after birth, surgery
resulted in adequate bile flow in 64.7% (11/17) of patients who could be
evaluated as compared with 31.8% (7/22) for surgery at 61 days or later (P less
than .05). Of the patients with adequate biliary drainage 11 had no apparent
liver disease, but only two of the patients with poor drainage were free of
clinical liver disease. The conclusion from this series is that a combination of
timely surgery, intestinal conduit at least 40 cm in length, and subsequent
long-term antibiotic prophylaxis favors the best bile flow and reduces the
occurrence of cholangitis, resulting in the best outcome